Healthcare Provider Details

I. General information

NPI: 1962275230
Provider Name (Legal Business Name): HEAL THY ENERGY EXPRESSIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MEMORIAL DR STE 138
STONE MOUNTAIN GA
30083-3155
US

IV. Provider business mailing address

3744 E PONCE DE LEON AVE
CLARKSTON GA
30021-1809
US

V. Phone/Fax

Practice location:
  • Phone: 678-743-1965
  • Fax:
Mailing address:
  • Phone: 678-743-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURIE JONES
Title or Position: CEO / DIRECTOR OF OPERATIONS
Credential: ND, MPH, LPC, NCC
Phone: 678-743-1965